Paar IT orp - 3 (fram at sofa 4 ain tafe) Government of Nepal Ministry of Foreign Affairs, Central Passport Office PASSPORT APPLICATION sera oes eod er thovy gent nm pear eae non CATAL ey Personal Information: 4. Sumamele * B)(A)(S](N}E)[T i 2. Given Names/ars A 3, Place of Binnie 4 Nationaliyretegaat > 7. clzsehip or Permit Nona + (Bonen ee APE 2)(0)[s) 4) (0) [7] 0. Pac of ner * Boer DIJAJIN|IG 10A. Date of issue xo/artr wea Tih € #108, Place of Issuerart are ear tt. Addresstarn “OM | 114. Disticttrre -[D][A][N][ are. TOSI OPIMRIOL HC. Ward No, FO] 6 ‘1D. Tow case ae DI[TI[PI[N|[A][G][a][R eee 12, Emails basnetsaroja@yahoo.com 18. Phone Not 4 9849179070 44, Next of Kin/sray Naa Riingmerttn ee VEINS NEL) 148, Adsressi2"0™ 146. Distictfrrat *[D] [A] [N ‘Bea arian! YOSIOFPMR “4E, Ward No, [O][6 ‘4, Towntage [D)(1][P][N][A](S][A]LR Ha. Hewete Fa ][0. [ 48, Relatonshiparar = 16. Phone Novas B)(R}(O}(T}(A)E}IR 9841441024 17. Emaivziq_ deepbasnet@hotmail.com Ra ere aes ere eta ah wat Thumb impr Applicants Signature@zaat #1 * —_ Datefaf , 2067/09/16 ‘Ventying Oficor Name & Signature Saree Designation: Dat: “ FOR OFFICE USE ONLY : ss Please fill in the appropriate box with an "X" mark. a ‘Application Source & Name Name Tene po [7] pistict [—] Mission Set Application Type Regular Emergency [~] New Extension Document Type Ordinary Diplomatic cia! [— ] Travel Document sur sa a